88R6694 BDP-F
By: Hinojosa S.B. No. 731
A BILL TO BE ENTITLED
AN ACT
relating to the proof required to impose payment holds in certain
cases of alleged fraud by Medicaid providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.102(g)(3), Government Code, is
amended to read as follows:
(3) On timely written request by a provider subject to
a payment hold under Subdivision (2), other than a hold requested by
the state's Medicaid fraud control unit, the office shall file a
request with the State Office of Administrative Hearings for an
expedited administrative hearing regarding the hold not later than
the third day after the date the office receives the provider's
request. The provider must request an expedited administrative
hearing under this subdivision not later than the 10th day after the
date the provider receives notice from the office under Subdivision
(2). The State Office of Administrative Hearings shall hold the
expedited administrative hearing not later than the 45th day after
the date the State Office of Administrative Hearings receives the
request for the hearing. In a hearing held under this subdivision:
(A) the provider and the office are each limited
to four hours of testimony, excluding time for responding to
questions from the administrative law judge;
(B) the provider and the office are each entitled
to two continuances under reasonable circumstances; and
(C) the office is required to show probable cause
that the credible allegation of fraud that is the basis of the
payment hold has an indicia of reliability and that continuing to
pay the provider presents [an ongoing significant financial risk to
the state and] a threat to the integrity of Medicaid due to:
(i) an ongoing risk that the alleged fraud
could result in the provider or another person receiving an
unauthorized benefit of more than $100,000; or
(ii) the provider's conduct having resulted
in a serious threat to the health or safety of recipients or the
possibility that the provider's conduct may result in that serious
threat at any time.
SECTION 2. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2023.